One thing that my husband and I can’t quite agree on is how much to moisturize – I like to slather huge amounts (think pressing the bottle pump vigorously, and just applying VERY liberally) while my husband prefers to pump with measured control as he feels that too much moisturizer get wasted on the clothing and when my baby hides under the blanket to escape from us). So how much is enough? And when to moisturize?
Let’s first establish that moisturizing is a must; it’s the one advice that I had from Marcie’s doctor Prof Hugo Van Bever, and in his words “You Can’t Moisturize Enough”. In a later follow-up consultation even after Marcie’s eczema is under control, his advice is still to continue moisturizing.Moisturizing helps to restore the skin barrier which is typically broken/thin in eczema skin, and that allows irritants and allergens to penetrate the skin. Moisturizer helps to trap water (after a bath) and also retain moisture in the skin. As you can see in the chart, people who moisturize more had to pay less visits to the doctor. I also read that the more moisturizer one uses, the less severe the eczema is.
So, how much to Moisturize? From what I’ve read is 400-500 grams per week, that’s one bottle of QV 500ml lotion or 2 bottles of Physiogel lotion, which is also the amount that I’ve been applying for Marcie. If you read my budgeting post, you will know how much it cost.
Steroid first or Moisturizer first? That’s another item that my hubby and I can’t agree on, but I think he’s right. Steroid first, then moisturizer.
When to Moisturize? Immediately after shower, and roughly at every diaper change/ 2-3 times per day. Moisturize even when the eczema is under control and for whole body, not just the rash area.
What Moisturizer to choose? I’ve tried to decipher the ingredients with not much success, but have posted here on what to generally look out for.I’ve later read that silicone is to protect the skin, butylene to re-hydrate and prolipids to restore. I know that propylene glycol and sodium lauryl sulfate may irritate the skin. You can also refer to this link for more on the ingredients (I didn’t summarize them ‘cos I’d tried for 2 days to compare ingredients across brands and they just don’t label them the same way…)Whatever it is, don’t give up on moisturizing! Anyone has any brands that worked for your child? Do post in the comments, thanks!
Update on:
How Much to Moisturize – read this Q&A with dermatologist Dr Jeff Benabio here
On Steroid or Moisturizer first – read this Q&A with Dr Bridgett here
On which ingredients to avoid in skincare production – read this Q&A with Dr Verallo-Rowell here
15 replies on “How much Moisturizing is Enough?”
Prof Hugo didn’t particularly specify which way, and from my understanding from other docs and reading materials on this, either way will do as both have their pros and cons.
To put the steroid first, meant it’s closer to the skin, and then moisturizer as a ‘sealing’ of the steroid.
To put the moisturizer first, then steroid later will prevent less spreading around of the steroid from the area you want.
No studies on whether this/that first, I put steroid first as I think the spreading around a little is ok since the skin inflammation actually is more than the reddish area we see.
Above helps? Cheers!
Mei
Hi Mei,
Nice website you have here. Alot of useful information to be found. There was a link you posted on the steroid phobia from eczema.org.
In the article, it mentioned that the steroid cream should not be used together with moisturizer, however my boy’s doctor (Dr Lee Bee Wah from Mt Eliz) told us to put the steroid on and then another layer of moisturizer on top. Can I know what Dr Hugo’s instruction was for Marcie?
Thanks.
Thanks Teri for dropping a comment and sharing about restoraderm – saw it on shelf but didn’t try since AI works for my tot 🙂 I’m like a dinosaur, it’s hard to convince me to change products. I’m not even on facebook, do help to share my blog posts on your FB, thanks!
Hi I have been using physiogel AI cream for 2 years now for my toddler. It was one of the best but I still need to mix in olive oil to make the moisturizing effect last. My sister in law got me a new product by cetaphil from a doctor to try. It is call restoraderm skin Restoring moisturizer. I have been using it for the past 3 weeks, not only the moisturizing effect is lasting, it seems to reduce the itch for my son as well. It definitely works better than my physiogel concoction with olive oil. you can try tan tock seng online pharmacy to purchase or get more information.
BH,
Thanks for your sharing and you’re right that mindset is important! You can read Dr Bridgett Combined Approach series on my blog, he is one of my featured guest. A psychiatrist with interest in dermatology.
Cheers!
During my flare up in May, I’ve seen Dr Mark Koh and he cured me. Was on 15 days steroid + steroid application + loads of moisturizer + 9 sessions of phototherapy. After suffering for more than 2 months, I was on the road to recovery (90% recovered). I started exercising for 2 weeks and my eczema returned. The flare up is once again all over body, arms and legs. But this time round, I’m taking it really easy (in terms of mindset) and not stressing myself over it. In addition, I’m using full strength steroid cream initially to control the eczema, then reduce to 1/2 strength now. So far the eczema is quite well controlled although it doesn’t seem to go away. I think mindset plays a very important role in managing eczema.
For moisturizer, I’m using various brands eg Dermaveen, QV, Aqueous and Physiogel. I once saw a news reporting about toothpaste. Docs in Taiwan recommends against using the same brand of toothpaste for long term as some brand may have a surplus/deficit of some minerals/chemical. It is advisable to use different brands. So I use the same logic on moisturizer too.
HI BH,
Maybe you can try to get off using aqueous cream? In recent years, there’s increasing reports on people being allergic to it.. I know Physiogel AI is so expensive, would you like to read my sensitive skincare product series, in particular the post below? As long as it doesn’t contain the top allergen, would be inceasing likelihood your choice of moisturizer is safe.
http://eczemablues.com/2012/02/sensitive-skin-product-series-what-ingredient-to-avoid/
Thanks for your reply. My flare-up is quite bad, like chicken pox ie all over the body with concentration on the chest (like Singapore map). Instead of 15 mins steroid application, I spend almost an hour on it. Not exaggerating. Rest for half hour, apply Aqueous cream, then another hour later, AI cream because I find that Aqueous cream doesn’t help retain moisture well as I still itch a lot.
I find the AI cream is effective for eczema, controls the itch well but I’ve got urticaria too. Been waking up the past few nights and found myself scratching vigorously.
I did a few blood tests but couldn’t detect any abnormalities. Dermatologist say it could be any possibilities, stress, heat, pollen, paint, dust, mozzie bites, etc….
As my girl’s eczema is localized, not full body, I didn’t need to apply steroid everywhere. It takes me only 1-2 minutes to finish steroid application, then I apply moisturizer. I read that doing so can allow the moisturizer to act as a dressing over the steroid cream.
However, if you take 15 minutes to apply steroid, I think it’s best you apply moisturizer first otherwise your body will dry. So, seems to me what you’re doing is good. What do you think.. has it been helping your skin? Btw, have you taken an allergy test? To have full body requiring steroid seems to be requring further consultation with doctor..
Im glad I found your site while googling for reviews on Physiogel AI cream. I’m suffering from eczema flare ups (head to toe) 8 years ago. And my son (6) just recovered from his eczema too (hands, elbows, knees and feet).
I’m slightly confused here. When you say to apply steroid immediately after bath, followed by moisturizer, won’t you be spreading the steroid cream all over your body? And are you still able to retain the moisture within the body since application of steroid cream to whole body takes quite a while (I take around 15 mins to apply my whole body).
So for my case, what do you suggest? I’m currently applying moisturizer immediately after shower, wait for 15-30 mins before applying steroid cream, then wait another 15-30mins and reapply another layer of moisturizer.
Hey Darren, thanks for pointing me to the article 🙂
I would think both ways are ok but I mentioned in my post that I followed my hubby’s way of putting steroid first cos we have no time to wait for the moisturizer to dry! We usually apply steroid after bath, once a day max for us now cos Marcie’s skin is better. And from birth till now, Marcie is still very naughty right after shower, literally jumping on the bed and refused to wear diapers! So, we’d quickly put steroid, then slap lots of moisturizer on her and as she runs around. I think if you’ve time to wait for the moisturizer to dry, then definitely ok to put steroid after.
But the more important thing is to chlorhexidine eczema patches to remove staph, then put steroid. That’s the specific instruction from Marcie’s doc.
Hi mei,
Steroid first or Moisturizer first?
I know that you have tried to apply steroid follow by moisturizer. However I was reading from http://www.patient.co.uk/health/Emollients-(Moisturisers)-for-Eczema.htm . they are advising the other way round.
Can you tell the difference of doing there and which is the correct way?
I just read on NY Times article “What to Ask About Eczema” that moisturizer should not be applied on top of medication.
Article link: http://www.nytimes.com/ref/health/healthguide/esn-eczema-questions.html
Glad you find this site useful! If you have any experience to share, especially skincare tips that worked for you, do feel free to drop a comment. 🙂
Hi,
I just stumbled on your lovely site and wanted to comment on how great it is! I’m not a parent but I’ve been dealing with eczema since I was one year old. It’s hard to find up-to-date and informative eczema blogs and I must say that your blog is fantastic! I hope it helps a lot of parents out there as well as fellow eczema sufferers. =)